Transition Shock

Once you're out of school and the reality of your chosen profession hits you, it can be quite overwhelming, no matter how thorough your schooling was.

So what can you do to survive (or better yet thrive) during your first year out there? Here are some tips to get you started:

Be patient with yourself. You're just starting out. Take time to learn and gain experience. Most seasoned nurses agree it takes a good year to become somewhat comfortable and two years to be able to handle most situations. Go easy on yourself and think about how far you've already come. Even the most competent nurse once started out exactly where you are now.

Focus on the positive. While it's human nature to dwell on the negative, if you focus on the positive, that will become your reality. At the end of each day, reflect on what you learned and on at least one good thing you did for someone. Write it down, look at it, and fall asleep with that thought in mind. Keep a positive journal of the times you made a difference or helped someone, including any nice things people say about you. Review it often.

Help others. It's never too soon to lend a helping hand to a coworker. You might even learn something in the process. Show your willingness to help, and others will do the same for you. Be sure to extend yourself to students and other new grads who follow you. Treat others as you wish to be treated.

Align yourself with positive, competent people. Experienced and friendly people are all around. Buddy up with those after whom you'd like to model yourself. A person doesn't have to have the same title as you for you to learn something from him or her. Many RNs have told me they learned everything they know from an experienced LPN.

Show some initiative. Don't wait for someone to tell you to do a procedure. Seek out opportunities to get the experience you need. If certain procedures aren't done with any frequency on your unit, talk to your preceptor, unit educator, or nurse manager about getting that experience elsewhere. If a certain procedure is going to be done on your unit, see if you can participate (or at least observe). Show your willingness to learn.

Build good relationships. Don't wait for others to come up to you. Introduce yourself to coworkers on all three shifts, to physicians, and to others. Have lunch with someone you don't know, and get to know him or her better. Learn others' names, and use them. Say good morning and good night to everyone. Become part of the team.

Keep learning. Use your drug reference guide, the Internet, policy and procedure manuals, and other resources. Ask questions, observe experienced people, and ask more questions. Remember-you have to do something for the first time only once. Then it starts to be old hat. Do your homework at the end of each day, and look up things that are new to you. Remember-this is phase two of your education.

Join professional associations. Become a member of your state nurses association and specialty association. These affiliations help you stay on the cutting edge, provide sources of support and help, offer educational programs, and give you a forum to share ideas, and so on. Don't stay isolated within your department and your facility. Become part of the greater whole, and develop close ties with your colleagues on state and national levels.

Track your progress. We all have a tendency to look at where we are now and where we still want to go. We lose sight of the progress we've already made and keep making. Consider starting a log. Record your accomplishments periodically, including any new procedures you do. Start with what you've already done, including getting through school ready to take the boards, and keep adding to it. Review it on a regular basis to see how far you've really come.

Manage your stress. Stress is not something to be tolerated; it should be managed. Everyone has stress in his or her life. As caregivers, we're particularly susceptible. Make time to socialize, engage in leisure activities and hobbies, exercise, meditate, and so on. That way, you'll have more to give your patients, your family, and yourself.

Stay focused, and keep moving forward. With the passage of time, you'll become more confident and comfortable in your new profession. You can do it! How do I know that? Because I was once right where you are now.

Well, I'm a new nurse myself (still in my orientation period), so I don't have a lot of advice to give, but the PP gave some great advice.

I have been trying my best to take my time, do things the way I was taught, and if I don't know how to do something, ask! I know that no one is expecting me to know everything already.

One thing that helped me a lot was that I worked as a CNA while I was in nursing school. So I am already comfortable with the basics: giving a bath, transfering, toileting, etc. It also helped me to become comfortable in a healthcare setting. And I made sure the nurses knew I was a nursing student and if I had time I would love to observe and assist (within the scope of practice for a CNA) when they needed to do a cath, dressing change, etc.

Best of luck to you as you finish nursing school and begin your career!

I too, am a new nurse and am feeling overwhelmed, I can't imagine remembering all the things I need to and giving my patients the care they deserve and in a timely manner. I feel like my prioritization and organization are horrible and am feeling very frightened, any more advice?

Choose your first employer carefully (if that's possible in today's economic environment). It is better to forgo a higher salary for a supportive, long orientation. (Mine was 5 months, with three months on the unit working under a preceptor.)

Don't be afraid to ask for help when you are in over your head. You orientation can make or break you. Ideally, you should have orientation last 3-6 months depending on which unit you go. This wasn't the case with me and it caused a lot of stress. Make sure you and your preceptor are a good fit. Having a nurse that loves to teach is a big plus. Pick an area of nursing that you like. If you don't like med-surg, you don't have to work it but realize nurses in areas like ICU, ER, OR many not be real fond of new grads in a specialty area. Don't let that discourage you though. Take your lunch and dinner breaks. Take frequent bathroom breaks. Sit down during your shift! Find hobbies outside the hospital/nursing home/etc. You don't have to pick up the phone every time work calls. Also, don't let work bully you into coming in when you really don't want to. It's okay to say no. Best wishes!

Realize that no one expects you to know absolutely everything right out of the gate. Many years ago an LPN instructor once told me that you will learn more in your first two years of practice than you ever did in school. I wasn't sure about this when I heard it, but it is true. When you look back over your first couple of years out of school you will be amazed at how much you can do and how little you could do right after graduation.

Good luck!

I remember the first year was awful - then I noticed three important things:

I had not killed anybody yet

Experienced nurses still sought advice from peers

I began repeating phrases, procedures --- they got a little easier with repitition

I started working as a new grad 6 weeks ago. I've learned more than I ever learned in nursing school. Listen to everyone. Learn from everyone. Get help. Ask questions. Be very humble and honest. Be strong, and of good courage. Pray alot. Keep trying. Be patient with yourself. Keep doing your best, and your best will get better. Don't obsess over your mistakes. Leave work at work. Have outrageous fun in your off time. Focus on the needs of the people you are with at the time. At work, your patients. At home, your family.